title: [Adult-onset Still's disease as a manifestation of malignancy: report of a patient with melanoma and literature review].
abstract: BACKGROUND
  A malignancy must be carefully excluded before ruling in the diagnosis of adult onset Still's disease (AOSD). However, an occult or poorly symptomatic malignancy can easily be overlooked.
  
  
  METHODS
  We report a 50-year-old female patient who presented with features of adult onset Still's disease (AOSD), in fact heralding a malignant melanoma with fatal outcome since discovered lately, at a metastatic stage. In retrospect, the only significant atypical feature was cholestatic hepatitis, which soon disappeared upon institution of glucocorticoid treatment. The literature review identified 27 additional cases of AOSD-like disease associated with malignancy published since 1980 including solid cancer in 61% of the cases (especially breast and lung) and haematological malignancies in 39% of the cases (especially malignant lymphoma). The interval between OASD-like symptoms and malignancy averaged 8 months, and AOSD most often preceding malignancy. Although idiopathic AOSD and neoplastic AOSD-like disease are often indistinguishable initially, some features could point toward the latter: an onset of AOSD after the age of 40 years, the presence of atypical clinical, biological, or immunological features in less than one third of the cases, and a poor response to NAIDS or systemic glucocorticoids in 61% of the cases.
  
  
  CONCLUSIONS
  Making the differential diagnosis of malignancy-associated AOSD in a timely fashion remains a primary goal, even in the most typical cases and those showing good initial therapeutic response.
authors.affiliation: Service de médecine interne A, clinique médicale A, CHU Dupuytren, 2, rue Martin-Luther-King, 87042 Limoges, France. Electronic address: liozone@yahoo.fr.
authors.forename: E
authors.initials: E
authors.lastname: Liozon
authors.affiliation: Service de médecine interne A, clinique médicale A, CHU Dupuytren, 2, rue Martin-Luther-King, 87042 Limoges, France.
authors.forename: K H
authors.initials: KH
authors.lastname: Ly
authors.affiliation: Service de médecine interne A, clinique médicale A, CHU Dupuytren, 2, rue Martin-Luther-King, 87042 Limoges, France.
authors.forename: E
authors.initials: E
authors.lastname: Vidal-Cathala
authors.affiliation: Service de médecine interne A, clinique médicale A, CHU Dupuytren, 2, rue Martin-Luther-King, 87042 Limoges, France.
authors.forename: A-L
authors.initials: AL
authors.lastname: Fauchais
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008545:Melanoma / Q000150:complications* / Q000175:diagnosis*; D008875:Middle Aged; D012878:Skin Neoplasms / Q000150:complications* / Q000175:diagnosis*; D016706:Still's Disease, Adult-Onset / Q000175:diagnosis* / Q000209:etiology*
keywords: Adult onset Still's disease; Cancer; Lymphome malin; Maladie de Still de l’adulte; Malignant lymphoma; Paraneoplastic syndrome; Syndrome paranéoplasique